比较术前纳米碳定位和术中肠镜定位在腹腔镜直肠腺瘤切除术中的作用及经验。

回顾性分析南京中医药大学附属南京中医院2016年1月至2020年6月行腹腔镜直肠腺瘤切除56例患者临床资料，分为纳米碳组和术中肠镜组，两组均行腹腔镜手术。纳米碳组：在手术日前1日，行结肠镜检查，在肿瘤肛侧距肿瘤边缘约1 cm黏膜下注射纳米碳，分别在3、6、9、12点分四处注射，每点注射0.25 mL。术中根据纳米碳标记，确定下切缘。术中肠镜组：切除肠管前，经肛门行肠镜检查，进镜至腺瘤或病灶下缘，根据肠镜光源，腹腔镜下在腺瘤部位予钛夹标记，并确定拟切除肠管范围。两组术后随访4~24个月。

两组肿瘤均准确定位，切除肠管均带瘤，无漏诊或误诊，切缘阴性。根据TNM分期法，纳米碳组30例，术后病理17例为Ⅰ期（T_is-1N₀M₀）肿瘤，13例为Ⅱ期（T₂N₀M₀）肿瘤。下切缘距肿瘤（2.1±0.5）cm。清扫淋巴结（23.42±4.80）枚。术中肠镜组26例，术后病理12例为Ⅰ期（T_is-1N₀M₀）肿瘤，14例为Ⅱ期（T₂N₀M₀）肿瘤。下切缘距肿瘤（2.5±0.4）cm。清扫淋巴结（16.33±5.87）枚。两组清扫淋巴结数差异有统计学意义（t=1.41，P=0.003）。

在腹腔镜直肠腺瘤切除行术前纳米碳定位和术中肠镜定位，准确性高。纳米碳定位可以增加清扫淋巴结数，更具优势，值得临床推广。

To compare the effect and experience of preoperative nano carbon localization and intraoperative colonoscopy localization in laparoscopic resection of rectal adenoma.

The clinical data of 56 patients who underwent laparoscopic resection of rectal adenoma in Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from January 2016 to June 2020 were retrospectively analyzed. They were divided into nano carbon group and intraoperative colonoscopy group. In the nano carbon group, colonoscopy was performed one day before the operation. Nano carbon was injected into the mucosa about 1 cm away from the edge of the tumor on the anal side of the tumor, and 0.25 mL was injected into each point at three, six, nine and twelve points respectively. During the operation, the lower margin was determined according to nano carbon labeling. Intraoperative colonoscopy group: Before bowel resection, enteroscopy was performed through anus, and the endoscope was moved to the lower edge of adenoma or lesion. According to the light source of colonoscopy, laparoscopic titanium clip was used to mark the adenoma site, and the scope of bowel to be removed was determined. The two groups were followed up for 4~24 months.

All the tumors were resected with negative margin by accurate locating. there is no missed or mistaken cutting. In both groups, the resected bowel includes tumors. According to TNM staging method, In the nano carbon group, seventeen cases were stage Ⅰ(T_is-1N₀M₀), and thirteen cases were stage Ⅱ(T₂N₀M₀). The distance between the lower margin and the tumor was (2.1±0.5) cm. The number of lymph nodes which were dissected were 23.42±4.80. In the intraoperative colonoscopy group, twelve cases were stage Ⅰ(T_is-1N₀M₀), and fourteen cases were stage Ⅱ(T₂N₀M₀). The distance from the lower margin to the tumor was (2.5±0.4) cm. The number of lymph nodes which were dissected were 16.33±5.87. T-test analysis showed that the dissected lymph nodes in the nano carbon group were more than that in the intraoperative colonoscopy group (t=1.41, P=0.003).

In laparoscopic resection of rectal adenoma, preoperative positioning with nano carbon localization and intraoperative positioning with colonoscopy have high accuracy, and nano carbon localization has more advantages in increasing the number of lymph node dissection, which is worthy of clinical promotion.